Helping primary care providers recognize and respond to medication non-adherence and drug-drug interactions: A randomized-controlled clinical utility trial in a value-based care setting
Trever Burgon, David Paculdo, Joshua Schrecker, Kelsy Gibson Ferrara, Randy E. David, Steven Johnson, Czarlota Valdenor, John W. Peabody
Abstract
To determine the clinical utility of a novel chronic disease management test among primary care providers practicing in a value-based care setting. The study assessed the ability of primary care providers to recognize and respond to medication nonadherence (MNA), drug-drug interactions (DDIs), and disease progression.
Introduction
Patients with chronic diseases and worsening symptoms are challenging to manage in primary care [1]. A typical management paradigm is to assess the patient’s symptoms and adjust or change medications as necessary. This may be combined with additional laboratory tests, imaging, or referral to a specialist.
Methods
Beginning August 17, 2022, and running between August 2022 and December 2022, 150 primary care providers within a large, multi-state practice were recruited to voluntarily participate in a randomized controlled trial (RCT) by caring for online, virtual patients.
Results
One hundred and fifty individuals completed the first round of data collection and the provider survey (Fig 1). Of these, 11 reported that they could not complete the second round of data collection due to time constraints. In all, 139 participants completed all six virtual patient cases across the two rounds (Table 1).
Discussion
Chronic disease management is a consequential challenge facing primary care providers, especially in value-based care arrangements where clinical and financial success is tied to keeping patients healthy and out of the hospital. When patients present with worsening symptoms, it is incumbent on providers to investigate common causes of their symptoms, including medication nonadherence and drug-drug interactions.
Conclusion
Identification of medication nonadherence and drug-drug interactions is one of many clinical challenges that providers face when treating chronic disease patients who remain symptomatic. In an experimental study, the introduction of an objective, saliva-based test significantly improved diagnostic accuracy for MNA and DDIs and led to more relevant treatment plans.
Citation: Burgon T, Paculdo D, Schrecker J, Ferrara KG, David RE, Johnson S, et al. (2026) Helping primary care providers recognize and respond to medication non-adherence and drug-drug interactions: A randomized-controlled clinical utility trial in a value-based care setting. PLoS One 21(3): e0344906. https://doi.org/10.1371/journal.pone.0344906
Editor: Masaki Mogi, Ehime University Graduate School of Medicine, JAPAN
Received: May 28, 2025; Accepted: February 25, 2026; Published: March 16, 2026
Copyright: © 2026 Burgon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the paper and its Supporting Information file.
Funding: This study was funded by Aegis Sciences Corporation, Nashville, TN, USA. The funders had no role in data collection, analysis, or decision to publish. The funder provided support in the form of financial compensation to QURE Healthcare for study implementation, analysis, and manuscript preparation. An employee of the funder, JS, is a co-author of this manuscript. The specific role of this author is articulated in the ‘author contributions’ section.
Competing interests: QURE Healthcare’s proprietary patient simulation platform was used to collect data and score responses. JS is an employee of Aegis Sciences Corporation which funded the study. There are no additional disclosures to report. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
